MEDICARE: MEDFUND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC5202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470001847	OTHER	FL	RR MCARE
2	V2652	OTHER	FL	BCBS PROVIDER #
3	470001841	OTHER		RAILROAD MCARE #
4	105715-19	OTHER	FL	CITRUS HMO
5	103905414	OTHER		DEPT OF LABOR/ACS

General Provider Information

NPI Number	:	1437152543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFUND LLC

Provider Business Mailing Address
First Line	:	240 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-5945
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	150 N UNIVERSITY DR
Second Line	:	STE 110
City	:	PLANTATION
State	:	FL
Zip	:	33324-2004
Country	:	US
Telephone Number	:	954-423-3674
Fax Number	:	954-916-0674

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. MARTIN J KERN
Credential	:
Telephone Number	:	941-925-3490

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/17/2018

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Directions to “MEDFUND LLC ” Practice Location

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